last presidential campaign. the democratic leaders in congress are advancing their extremist health care reform bills with bare minimum of votes to do the job. i disagree with that approach. health care is one-sixth of the economy. that's as large as the entire british economy. the legislation congress is considering will affect every american at every level of health and at every stage of employment. when the debate -- when the debate began last year, in fact it was just this month in november that i remember eight or 10 of us from different committees met with the solemn pledge, we were going to work together in a bipartisan way to get this job done.

we met again for the next six months several times. but it just didn't work out. but when that debate began last year, interested legislators of both parties, we set benchmarks that were really no brainers. health care reform should lower the cost of premiums. it should reduce the deficit. it should bend the growth curve in health care the right way, downward. now, the reid bill doesn't do any of these things. it's not too late to start over. and i guess senator baucus has put forth that invitation. i hope it materializes. if both sides can set aside some philosophical differences, and if the democratic leaders are willing to refocus on the principles that brought us to the table months ago, i believe we can produce health care reform that improves the quality of life for americans who are

suffering under the current health care system and doesn't degrade the quality of life for everyone else. but it's not the entirety of this 2,054-page bill. these issues can be addressed without the result of higher taxes, higher insurance premiums and deficits and debts that will get in the way of opportunities that result from the ingenuity and productivity and industry of the american people. so i get back to that coffee shop meeting where people are discussing health care reform and as i walk into that coffee meeting, and i tell them that this 2,054-page bill increases

taxes, increases premiums, tak takes $400 or more billion out of medicare and it doesn't do anything about controlling costs, according to the congressional budget office, that group again would say, well, that doesn't sound like health care reform to me. as we start this debate this week then, i urge my colleagues to listen to the american people. the reid bill is in the wrong direction. i yield the floor. the presiding officer: the senator from arizona. mr. mccain: i ask unanimous consent to send to the desk at this time a motion to commit with instructions. the presiding officer: without objection. the clerk will report the motion. the clerk: the senator from arizona, mr. mccain, moves to

commit h.r. 3590 to the committee on finance with instructions to report the same back to senate with changes that do not independent clued the following: one -- mr. mccain: madam president, that further reading of the motion be dispensed with. the presiding officer: without objection. mr. mccain: madam president, simply put this motion to commit would be a requirement that we eliminate the half a trillion dollars in medicare cuts that is envisioned by this bill. a half a trillion dollars in cuts that are unspecified as to how, and half a trillion dollars in cuts that would directly impact the health care of citizens in this country. medicare advantage cuts totali totaling $118 billion. an independent medicare advisory board that would cos cost $23 billion.

expansion of medicare hospital penalties totaling $7.1 billion. home health care cuts totalin totaling $42.1 billion. hospice -- of all of the things, hospice, some $8 billion. and the list goes on and on. all of these are cuts in the obligations that we have assumed and are at the rightful -- rightful benefits that people have earned in our -- and our citizens -- our senior citizens across this nation. this is -- this eliminates a half a trillion dollars in cuts to medicare that are cuts which are unspecified. i will eagerly look forward to hearing from the authors of this legislation as to how they can possibly achieve a half a

trillion dollars in cuts without impacting existing medicare programs negatively and eventually lead to rationing of health care in this country. that's what this motion is all about. this motion is to eliminate those unwarranted cuts. now all of us know that there are enormous savings in fraud abuse an twheas can be eye -- and waste that can be identified. no expert that i know of believes that that would come up to a half a traldz. -- half a traldz. hospitals are cut b by $105 billion. nursing homes are cut b by $14.6 billion. and hospices are cut b by $7.6 billion. these are not attainable cuts without eventually rationing health care in america and

rationing health care for our senior citizens who have earned these benefits and we have guaranteed them these benefits. and for the life of me how the aarp can support this 2,000-page legislation is beyond my imagination. seniors all over america and all over the state of arizona, including the 330,000 senior citizens in my state that are under the medicare advantage program, which is going to be drastically cut by som some $120 billion, are outraged. and the more they find out about it, the more angry they've become. so here we are, as my colleague from the great state of iowa and a leader on health care just articulated, in a totally partisan measure before the united states senate in which no

member on this side of the aisle has been consulted in any way -- i would point out to my colleagues historically there has never been a major reform implemented by the congress of the united states unless it's by a -- unless it's bipartisan in nature and i don't believe that the american people want this 2,000-and-some-page monstrosity, which is full of -- which is full of all kinds of provisions that they are either unaware of or even in the study of this legislation many of us have also become unaware of. but fundamentally the bernie madoff accounting, the enron accounting that's been going on with this bill is dependent on envisioning a half a traldz in cuts -- half a trillion dollars in cuts are not attainable.

if they are attainable, it would mean a curtailment or reduction in what we promised the senior citizens of this country. it's not acceptable. so what this -- what this -- this motion to commit does, it sends it back to the finance committee. come back with another bill. only this time don't put the cost of it on the backs of senior citizens of this country. don't do it. you know, it was back last summer three months before he was elected president on a campaign stop not far from washington, d.c., now president obama vowed not only to reform health care, but to do it in a new way. he said i will have all of the negotiations around a big table, televised on c-span so people can see who is making arguments on behalf of their constituents an who are making arguments on behalf of the drug companies or the insurance companies. americans wanted to believe this would be true.

republicans offered to work with the majority on our ideas, but that was rejected. and so what has happened? business as usual. let me read from a report this past weekend about business as usual. the associated press has moved a story saying that health care lobbyists and other interests have made $57 -- 575 visits to the white house between january and august. the report is based on records released by the white house on wednesday. the timing of the release smells of a classic washington tactic. dumping bad news on the gettaway date before a long weekend. clearly the white house, who has prized itself on being the most transparent administration in the history of the world, hopes that this nugget gets lost over the four-day thanksgiving day weekend. top aides to president obama have met early and often. democratic political strategists

and others with a stake in the administration of the national health care overhaul. white house visitor records obtained wednesday by the associated press. now, all of my fellow citizens who are watching on c-span, i urge you, call the white house. say you'd like to have an appointment. you'd like to have an appointment to meet with the president or members of the administration in the white house, 575 special interests were able to get in. why can't you? give them a call. tell them you'd like to meet with -- with the -- with the members of the administration. that's what 575 lobbyists have been able to do. give them a call. the record shows a record broad section of the people most heavily involved in the health care debate, except for average citizens. weighted heavily with those who want to overhaul the system. talks about whose among them, including the c.e.o. of kaiser

health plans, c.e.o. of blue cross blue shields, a washington lobbyist who represents blue cross blue shield. billy tozan, head of pharma, richard umdenstock, several lobbyists for powerful health care interests, including insurers, drug companies and large employers also visit the white house complex the records show. so, again, citizens why don't call the white house and ask for an appointment. the lobbyists and the special interests, the big donors get it. they're not ambassadors, they're lobbying the white house on this issue. my friends, health care reform should have been about both sides sitting down together an fixing what's -- and fixing what's broken. reducing health care costs while preserving the highest health care quality in the world. somewhere -- somewhere in the

course of this debate and the process of this legislation, we lost sight of the fundamental problem with health care in america and that's the cost of health care in america, not quality. and this legislation will destroy the quality and the availablity if the cuts envisioned in this legislation, in this enron accounting measure, where the first four years -- the first four years after this legislation -- after -- suppose that this legislation was signed on the first of january by the president of the united states. immediately benefits begin getting cut, immediately taxes go up, and guess what? none of the benefits will be given to any american citizen for four years. so that's how you get deficit-neutrality. that's how you get deficit-neutrality. if you started giving the benefits at the same time you

raise the taxes, my friends, you've got about $1.3 trillion in deficit in a $2.5 trillion bill. $2.5 trillion piece of legislation. my friends, here we are with the highest deficits in history, with a deficit and debts as far as we can see, with the stimulus package that has been done so well we now have 10.2% unemployment, and many predict that it's even going higher, but wall street's doing fine. and these lobbyists are doing fine. this one mr. tozan, the pharma lobbyist, he's doing fine. i understand his salary is around a couple of million dollars a year, not to mention all of the other perks. the average citizen, the 330,000 citizens of my state who have the medicare advantage program are going to see it cut and cut and cut over and over again.

about $120 billion worth. so what happened? the white house engaged in the tradition of handing out favors to special interest including pharma, aarp and a.m.a. and shame on aarp and shame on the a.m.a. we -- we know there are many commonsense reforms that americans want. we know they can work. by the way, in this monstrosity, find me any significant real medical malpractice reform. medical malpractice, the threat of it causes physicians to practice defensive medicine. the c.b.o. estimates that it would be roughly a savings of of $54 billion over ten years. that does not take into consideration the cost of defensive medicine that doctors

have to practice because of fear of being sued. i -- i would ask the distinguished chairman of the committee where -- where is any meaningful malpractice reform in this 2,000-page bill? hi a town hall meeting in arizona the other day as i do quite frequently and a lot of doctors came, they had requested it, doctors, nurses, and caregivers, and i asked them what do you do about medical malpractice reform, and every one of them, every one of them said we practice defensive medicine. we prescribe additional tests and procedures. we have to do it because we find ourselves in court by the trial lawyers. do not underestimate, my friends, the many special interests and their influence in this legislation, but do not underestimate the stunning success of the american trial

lawyers association who have made sure that there is no provision in this bill that has to do with medical malpractice reform. and by the way, if there is -- if there is an example, it's called the state of texas. the state of texas enacted meaningful and yet not draconian medical malpractice reform. premiums have gone down, cases have gone down, doctors are flooding back into the state of texas, and it has worked. so you're going to hear from the other side that there may be demonstration projects, there may be this, may be that. the demonstration project is the state of texas. that's all we have to do. it's already been proven. so instead of a reform which could save tens if not a couple hundred billion dollars, what are we going to do? we're going to cut hospitals by by $105 billion, nursing homes by $14.6 billion, hospices by

by $7.6 billion, and the list goes on and on, up to a half a trillion dollars. and my motion will send it back to the finance committee and tell them to remove these unnecessary, unneeded, unwanted, harmful cuts in the medicare system which will not allow us to fulfill our obligation to the senior citizens of this country. buried in this partisan legislation, as i mentioned, ten years of tax increases in medicare cuts that total over over $1 trillion. using c.b.o. numbers, this stack of partisan legislation costs costs $2.5 trillion over its ten-year implementation. so let me -- let me put this in different terms for you. suppose you want to buy a house, so you go and you buy the house but the terms of the contract of purchasing the house, you make

the payments on the house for the first four years and after four years, you can move in. that's why this is bernie madoff accounting. it's a sham. it's a sham. it's a sham to make people pay taxes and have their benefits cut at the -- for four years and then only after four years do the benefits kick in. that's the way with this kind of accounting they get to deficit neutral. it's crazy. it's crazy. so you increase taxes in medicare cuts begin impacting americans and our economy in 32 days if this were passed. let me repeat this. starting in january, 2010, just one month from now, a majority begins tax increases and medicare cuts. starting in january. incredibly delays implementation

of this bill for four years. that's 1,460 days and 208 weeks of new taxes and medicare cuts before implementation. that is playing games with the american people. if they weren't playing games by delaying the implementation of the bill four years after the tax increases and medicare cuts, we wouldn't even be discussing this pile of legislation because it would be scored as adding over a trillion dollars to our deficit. if the other side wanted to be honest and reject madoff enron accounting, they would be talking about the first ten years of real costs and the first ten years of their tax increases and medicare cuts. you know, the other day, the respected dean of the washington press corps, david broder, pointed this out just last week in his column in "the washington post" entitled "a budget buster in the making."

by the way, the majority leader then felt compelled to come down and trash one of the most respected columnists in america who i don't need to take the time to defend. he can defend himself and so will many others who have great respect for david broder. david broder's column said "it's simply not true that america is am biff leapt about everything when it comes to the obama health plan. the day after the congressional budget office gave its qualified blessing to the version of health reform produced by senate majority leader harry reid, quinnipiac university poll of a national cross-section of voters reported its latest results. by a 16-point margin, the majority in this poll said they oppose the legislation moving through congress." david broder went on to say -- "i have been writing for months that the acid test for this effort lies less in the publicized fight over the public option or the issue of abortion coverage than in the

plausibility of its claim to be fiscally responsible. this is obviously turning out to be the case. while the c.b.o. said that both the house-passed bill and the one reid has drafted meet obama's test by being "budget neutral," every expert i have talked to says that the public has it right. these bills as they stand are budget busters. here, for example, is what robert bixby, the executive director of the concord coalition, a bipartisan group of budget watchdogs told me." the senate bill is better than the house version, but there's not much reform in this bill. as of now, it's basically a big entitlement expansion plus tax increases. these are nonpartisan sources, but republican budget experts such as former c.b.o. director douglas holzaiken amplify the point with specific examples and

biting language. he cites a long list of democratic sponsored budget gimmicks that made it possible for the c.b.o. to estimate that reid's bill would reduce federal deficits by $130 billion by 2019. perhaps the biggest of these maneuvers was reid's decision to postpone the start of subsidies to help the uninsured buy policies from mid 2013 to january, 2014. long after taxes and fees levied by the bill would have begun. even with that change, there's plenty in the c.b.o. report to suggest that the promised budget savings may not materialize. if you read deep enough, you'll find that under the senate bill, "federal outlays for health care would increase during the 2010- 2019 period, not decline. the gross increase would be almost $1 trillion, $848 billion

to be exact, mainly to subsidize the uninsured. the net increase would be be $160 billion. but this depends on two big gambles. will future congresses actually impose the $420 billion in cuts to medicare, medicaid, and other federal programs? they never have. so why don't we tell the truth to the american people and take these supposed cuts out of this bill? and tell them the truth about what it costs and tell them the truth that this is a dramatic expansion of entitlements but at the same time those presently eligible, those senior citizens who are -- like the 330,000 that are under the medicare advantage program in my home state of arizona will not see that program maintained.

we cannot reach these kinds of savings, these kinds of reductions, these kinds of cuts without impacting existing programs, and i know of no expert who says that it will this is an objective observer. i believe that dr. coburn, dr. barrasso and others in the medical profession will say the same thing. every time that congress has enacted so-called cuts in medicare or contemplated it, they have never taken place. the doctor fix -- well, we took care of that problem. we just took it out of the bill. but you know what we're going to do about the doctor fix. every year we're going to delay it and delay it and delay it, every year, and it will never happen. that has been the history of the so-called doctor fix since its

beginning. and will this congress enact the excise tax on high premium insurance policies, the so-called cadillac plans in reid's bill? obama has never endorsed them and house democrats reacting to union pressure turned them down in favor of a surtax on millionaires' income. the challenge to congress and to obama remains the same -- make the promised savings real and don't pass along numbered -- unfunded programs to our children and our grandchildren. that means taking this legislation back, taking out these cuts in medicare and programs that are vital to our citizens of this country and come back with a realistic, a realistic piece of legislation that has malpractice reform, ability to go across state lines to get the health insurance policy of your choice, rewards for wellness and fitness, expansion of health savings

account, medical malpractice reform. there's many cost-saving measures that we can enact to bring the costs of roll call in america under control and preserve the quality. instead, we are doing just the opposite. if you're going to make these kinds of cuts, the $420 billion in cuts to medicare and medicaid and other federal health programs, then you are going to impact the provisions of health care in america. now, americans have been clear that overspending has to stop. nor do the american people believe that empowering washington bureaucrats in a new federal health care entitlement is health reform. the other side disregards the message from the american people all across the country, and the bill just does the opposite. i want to talk just for a minute about a provision in this bill that's very important, and that

is the transfer of power, the massive transfer of power in this bill to the secretary of health and human services. this is a huge transfer. a search of h.h.s. would become federal giant under senate plan by susan fariccio. a quick search of the senate health bill will bring up -- quote -- "secretary" 2,500 times. that's because health and human services secretary kathleen sebelius would be awarded unprecedented new powers under the proposal, including the authority to decide what medical care should be covered by insurers as well as the terms and conditions of coverage and who should receive them. i want to repeat that. in this bill, the secretary has the authority to decide what medical care should be covered

by insurers as well as the terms and conditions of coverage and who should receive it. now, we saw a little precursor of that just the other day with the recommendations concerning mammograms. a board recommended that women under 50 should not get routine mammograms. well, of course, the response was incredible and justified. women all over america who are now alive today because they had mammograms prior to the age of 50, and so -- and the secretary of health and human services said that that wouldn't be carried out, et cetera. we are creating a situation where the secretary of health and human services and a board would decide that. the legislation lists 1,697 times where the secretary of health and human services is given the authority to create,

determine, or define things in the bill, said devin harrick, a health care expert at the national center for policy analysis. for example, on page 122 of this 2,079-page bill, the secretary is given the power to establish, quote -- the basic enrollee per-month cost determined on actual actuarial basis including coverage under a qualified health care plan. the h.h.s. secretary would also have the power to decide where abortion is allowed under a government-run plan which has drawn opposition, obviously. and the bill even empowers the department to establish a center for medicare and medicaid innovation that would have the authority to make cost-saving cuts without having to get the approval of congress first. quote -- "it's a huge amount of power being shifted to h.h.s. and much of it is highly

discretionary," said edmond hausmaer, an expert in health care policy and insurance markets at the heritage foundation, a conservative think tank. hausmaer said "one of the greatest powers h.h.s. would gain from the bill is the authority to regulate insurance. states currently hold this power, and under the senate bill, the federal government would usurp it from them. this could le -- this could lead to the federal government putting restrictions and changes in place in destabilize the private insurance market by forcing companies to lower premiums and other charges, he said. quote -- "health and human services doesn't have any experience with this, housemeyer said. i'm looking at the potential for this whole thing to just blow up on people because they have no idea what they're doing. who in the federal government regulates insurance today? nobody. the health care reform legislation would rely on the u.s. preventive services task force for recommendations as to what kind of screening and

preventive care should be covered. last week, the group, which operates under h.h.s., as i mentioned, drew sharp criticism for advising that mammograms should begin at age 50, a decade later than the current standard. critics of the bill said this was an example of how the new bill would empower h.h.s. to alter health care delivery. but democrats argue they would rather have the government making these decisions. that's the key to it. they would rather have the government making these decisions. if you like the way the post office is run, you will love the way h.h.s. runs health care in america. i understand the other side's amendment may address some of this, but under the reid bill that the senate moved to consider, beginning in 32 days, the language from the bill on page1189 authorizes the secretary to modify benefits for

health care pursuant to task force recommendations. as i mentioned, how many women would have died if the coverage provision guiding the new federal plan under mammograms had been implemented? and then on the following page, 1190, the secretary is authorized to deny payment for prevention services that the task force recommends against. so if this unelected panel changes a preventive recommendation for some other type of cancer, the federal plan won't cover it. i don't think the american people want their health coverage decisions coming from a panel in washington. the reid bill drives up costs and premiums. just today, the c.b.o. released its assessment of what will happen to hurp health insurance premiums urn the new entitlement compared -- under the new entitlement compared with premiums today. the c.b.o. dealt a blow to claims that the health care bill

introduce bide senator reid -- introduced by senator reid will lower premiums when they released an analysis showing that premiums will go up significantly in the individual market. premiums for individuals without employer-sponsored coverage would increase 10% to 13%, or $2,100 per family, in 2016. the democrats' bill, therefore, requires individuals to purchase insurance that's more expensive than would be available under current law. for small businesses and employers, the bill largely preserves the status quo and does little, if anything, to lower their costs. in fact, c.b.o. estimates that under the reid bill, the average family with employer-sponsored coverage will soon pay more than $20,000 per year for health insurance. president obama said during the campaign, he said -- quote -- "i have made a solemn pledge that i will sign a universal health care bill into law by the end of

my first term as president that will cover every american and cut the cost of a typical family's premium by up to $2,500 a year." well, c.b.o.'s analysis shows that the president is breaking that pledge by both failing to achieve universal coverage and raising premiums, just as it contradicts an analysis by m.i.t. economist john gruber released by the white house this weekend claiming that individual premiums would go down. in fact, even with the generous assumptions made by c.b.o. in a number of areas, premiums will either go up or remain unchang unchanged. from the c.b.o. report just today, c.b.o. says that premiums in the individual market would be 10% to 13% higher in 2016 under current law. average premiums would increase by $300 for an individual policy

and by $2,100 for a family policy. the new benefit and coverage mandates actually drives up premiums by 27% to 30% and this increase is offset by other factors, like new administrative efficiencies. c.b.o. says a little more than half of enrollees in the individual market would receive a government subsidy. however, it is bill before us -- however, the bill before us will still require nearly 14 million americans to purchase unsubsidized insurance that is more expensive than the one they have today. president obama has promised that seniors will not see a reduction in benefits. in fact, he said recently, "people currently signed up for medicare advantage are going to have medicare and the same level of benefits." how to you yet in? how do you get -- how do you get there? how do you yet in when you're cutting medicare advantage by

$$120 billion? there is no math, old or new, that gets you to no change in the benefits that they have under medicare advantage and yet cut $120 billion. traditional medicare doesn't offer coordinated benefits that can improve the quality of care, and traditional medicare doesn't have many of the aides that benefit our seniors. president obama has also promised several times, if you like whawf, you can keep it -- like what you have, you can keep t. the american people took those words as a promise, and if they had a health benefit that they were happy with, they could keep it. i want to make sure we're helping the president keep his promise. i want to help him keep his promise by sending this bill back, taking out the cuts that are in it on medicare, on the $105 billion cuts in hospital, nursing homes, $14.6 billion, hospice, $7.6 billion, medicare advantage by $120 billion. send it back to the finance

committee and come back with a bill that the american people can believe in, that will preserve the obligations we've -- solemn obligations we've made to our senior citizens. medicare advantage provides the only choice in the medicare program. allowing an option for seniors who want additional benefits are a better option. medicare advantage is working for nearly 11 million seniors to give them a choice about their health care and better benefits. as i mentioned, 330,000 beneficiaries in my state of arizona are on medicare advantage, and they would see benefit reductions or their plan disappear. 89% of seniors need and have some form of supplemental coverage on top of medicare to provide protection against out-of-pocket costs or additional benefits. many low-income americans and minorities rely on medicare advantage as their supplemental

coverage. some have claimed that cutting the -- quote -- "extra payments to medicare advantage plans reduces insurance company profits. under federal law, that's simply not the case. the fact is, 75% of those extra payments go directly to extra benefits for seniors under current law. the other 25% goes back to the federal government. unfortunately, those extra benefits will be taken from seniors who are enrolled in medicare advantage. the bill contains $120 billion in direct cuts to private medicare plans. common sense says you can't do that without affecting benefits. the congressional budget office thinks so as well. c.b.o. assumes that the reid bill will cut benefits by more than half, from an average of $98 in additional benefits, to $41 a month.

so i've taken -- i see that one of my colleagues is waiting to speak. so i hope that the american people will understand what we're trying to do here. all we're trying to do is send this back to be reworked, to be fixed on a bipartisan basis, not to force $400 billion-and-some in cuts in benefits that we have promised the american people. send it back, come out with a bipartisan approach, sit down for the first time with republicans and democrats, have the c-span cameras in the way that the president promised -- promised -- that he would back last october a year ago, and let's sit down together and figure out how we can fix this. and the best way to fix it is to preserve the quality of health care in america and bring down the costs, not to pass a

2,074-page monstrosity that is full of the measures that would impair the ability particularly of our senior citizens to keep the benefits that they have earned and we have promised them. madam president, i yield the floor. a senator: madam president? the presiding officer: the senator from pennsylvania. mr. casey: madam president, i rise to speak about health care as we begin the debate in the senate. i'm grateful that we're finally at this point where the united states at long last will be debating our health care bill. and it's been a long time in coming. we know that some of us have waited years and some have waited for decades to be at this point in our history. on the floor now is the patient protection and affordable care act and we're going to be discussing various aspects of

that for the next couple of weeks. i'm reminded as i rise today of something hubert humphrey said a long time ago. he said, "the test of a government is how it treats those in the dawn of life, our children, those in the shadows of life, those who have challenges in their life that we try to help with, and those in the twilight of life, older oldr citizens across america. and in large measure, we'll be talking about each of those -- each of those americans in one way or another and a lot -- a lot of other americans as well. but i -- i rise to speak of our children but also to spend a couple of moments talking about older citizens and especially in light of some of the arguments made here most recently on the floor i'll start with our older citizen. i come from the state of pennsylvania, where in our little more than 12 million

pennsylvanians, we have almost a million pennsylvanians over the age of 65. we have a very high number of pennsylvanians on medicare and also a lot of families who rely upon that kind of -- that kind of health care coverage, as we have for many generations. so when we speak of those in the twilight of life, we speak of many americans who are covered by medicare. i wanted to make a couple points about the -- the bill that's on the floor now. first of all, with regard to older citizens, a couple of basic points that i'll -- i'll provide a little more background on. first of all, this bill as it relates to medicare will protect medicare's already guaranteed benefits. the bill also reduces premium premiums -- reduces premiums -- and co-pays for older citizens. it will ensure that older

citizens can keep their own doctors, doctors they've developed a relationship with, a doctor or more than one doctor that a -- an older citizen comes to' lie upon and has confidence in. we want to make sure they can keep their own doctor. the bill keeps medicare from going bankrupt in eight years by stopping waste, fraud and abuse and by other provisions as well. the bill provides new preventive and wellness benefits, something we've talked about for every age group but we're finally going to do something about to give people better health care outcomes. the bill also as it relates to older citizens lowers prescription drug costs. we'll talk more about that. we've -- we've had a lot of discussion over the last couple of years about the so-called doughnut hole, that very nice sounding way of falling into a period in your coverage if you're an older citizen getting prescription drug coverage where you have to pay the whole

freight, so to speak. this bill provides relief for those who are in that so-called doughnut hole with regard to medicare prescription drug coverage. it keeps -- and finally, this bill keeps older citizens in their homes and limits the -- limits those who would be compelled if they didn't get additional help to go into nursing homes. some do and some choose to do that but we want to provide more opportunity for people to stay in their homes if they can. now, in terms of preserving medicare without the changes made in this bill, medicare is going broke in eight years. not 18, not 80, eight years if we do nothing. older citizens will have trouble accessing their doctor if we don't take action. older citizens will have trouble affording prescription drugs if we don't take action. and finally, without reform,

cost sharing for older citizens will increase to completely unaffordable levels. next, we have to make sure that older citizens across america have the opportunity to continue to receive guaranteed protection of hospital stays, access to doctors, home health care, nursing home and prescription drug coverage. we have to make sure that we extend the life of the medicare trust fund beyond 2022. without reform, we can't extend the medicare trust fund beyond 2022. without reform, we don't have the opportunity to make sure that we ensure that that trust fund will be there for older citizens across america. and finally, health reform will not interfere with any medical decisions made by patients and their doctors. now, let me just step back a

moment and reflect upon what we're talking about here with regard to medicare, protecting -- protecting our seniors, protecting their -- protecting their benefits. it's interesting to neat in this whole debate, which really started january of 200in a fully engage -- january of 2009 in a fully engaged way when staffs of relevant committees were working on this month after month. that went into the summer, working in the health care reform in the health, education, labor, pensions committee, and in the finance committee, improving bills, changing the bills. and now we have one bill that's the result of all that work. so this has been going on for months and months and months. and i keep hearing criticisms from my republican colleagues on various aspects of the bill much there's nothing unusual about that. that's natural to have a discussion and a debate. we're starting that today. at least on the floor. but we've been having a debate over many, many months.

my point here is that you have -- on the one hand, you have the legislation that resulted from work by the two committees into one bill. you have the patient protection and affordable care act on the floor and you have ideas contained in that being discussed for many, many months. but what we haven't seen -- what i've been waiting for and haven't seen is a bill by the other side. in other words, when we were working in june and july in the "help" committee or when we were working in the other committee -- the finance committee was working all summer and into the fall, you would think that one of the results from that would be that democrats had a point of view and they produced a bill. and republicans had a point of view and didn't produce a bill. so you basically have a choice before the american people. the bill before us, which will change and which will be amended -- i have some things that i would want to change.

but the answer can't be, let's go back to square one where we were a year ago or five years ago or ten years ago and just cancel this and try to start over. this is the result of many, many years of work. and especially, many, many months of work by people at the staff level and senators across the board. but, unfortunately, the other side doesn't have a plan. so i can only conclude that they wapts to stay with the -- they want to stay with the status quo. they think where we are in health care is okay, that we should stay where we are, maybe tinker with it a little bit but not change much. i just think that's unacceptable. too many people that i've run into in pennsylvania especially have said to us, please provide some protections for me -- and they're talking about individuals who have health care -- provide some consumer protections, make sure that the medicare trust fund will always be there, help me with this doughnut hole problem, this

problem that too many seniors run into when they can't pay for prescription drugs at a certain point in the delivery of that benefit. but i don't think the response of doing nothing or staying where we are -- i don't think that's acceptable. and that's one of the reasons why we have to make sure we focus on changes or debates about this bill, not going back to where we were in january, where we were five years ago and basically doing nothing year after year after helt health care and just saying -- about health care and just saying, it's okay, just stay where we are. so we have a long way to go. but i think it's important to point out this isn't just a debate between republicans and democrats. we've had groups across the board who are neutral arbiters, who weigh in on public policy, who are not representing a democratic point of view or a republican point of view. the american association of retired americans, aarp, said on november 20 of this year -- and

i quote -- "opponents of health care reform won't rest. they're using myths and misinformation to distort of the truth and wrongly suggest -- wrongly suggest -- that medicare will be harmed. after a lifetime of hard work, don't seniors deserve better?" unquote. so says the aarp just a couple of -- just a couple of weeks ago, not even a couple of weeks ago; 10 days ago. the aarp also said on november 18, two days earlier, "the newe bill makes improvements to the medicare program by creating a new annual wellness program, and most notably for aarp members reducing drug quofts for seniors who -- costs for seniors who fall into the dreaded medicare doughnut hole ""-- that i spoke of earlier -- "a costly gap in prescription drug coverage." that's the aarp tbheag on -- not a concept, not a theory but the

bill before us. the american medical association, on that same day, november 20, 2009 -- quote -- "we're working to put the scare tactics to bed once and for all and inform patients about the benefits of health care reform." end quote. i could go on from there, but we have, i think, ample evidence that there's strong support for the ways this bill will strengthen medicare. let me move to another topic, and before i do that i do want to, for the record, madam president, ask unanimous consent that a member of my staff, ovniy shudniranai be granted floor privileges for the duration of the debate. the presiding officer: without objection. mr. casey: thank you. i wanted to turn to the other topic i was going to cover

tonight. that's what we do and what the test is of our government as it relates to those in the dawn of life. i spoke of older citizens a moment ago. the dawn of life -- our children. it's been a topic and a focus of mine since the very beginning of this debate, which for me began last spring when i was working in the health, education, labor, and pensions committee before our work this summer on the bill. the patience protection and affordable care act, which is the bill before us today, deals with so many aspects of our health care system. one of them is how we take care of our children. i've come back to this issue over and over again, and i've had just a basic test for this legislation, and it's very simple. it's really four word words -- o child worse off.

and especially children that are low-income and are particularly vulnerable, therefore, and children with special needs. so no child worse off should be the foundation of what we do in this bill for our children. particularly those who are, as i said before, vulnerable because they're low income or children with special needs. that's the foundation of what we should be doing. in terms of a guiding philosophy, the way i look at this is, every child in america, no matter who they are, no matter what their circumstance, every child in america is born with a light inside them. for some, that light is boundless, because of their circumstance, because of their ability, because of advantages they have, their potential is unlimited. and that light burns very brightly without any help from anyone else. that's some children. then there are other children who have a light inside them and are deserving of our care and protection and our advocacy.

we have a lot of people around here who get besieged by lobbyists for different points of view, but very rarely do we get the same kind of lobbying power, the same kind of power in our system to stand up for children. so we have to do that, if an interest group won't. and there are plenty that have advocated strongly for our children. but they don't get enough attention, nievment. but there are---- but there are some children who don't get attention because of particular vulnerabilities that they have. they are the ones that we have to fight the hardest for. they are the ones we have to stand up to the special interests for because they can't do it for themselves. they don't have a voice sometimes in this debate unless the united states senate stands up for them. so i believe that no matter what the light is inside a child, no matter what the limit or the --

or whether it is unlimited potential, we have to make sure that that potential is reached, the full potential. not most of it, not some of it, the full potential of every child. the full burning of that light inside them. now, two programs that work well to do that are medicaid and the children's health insurance program. thank goodness both of these programs came along. medicaid some 40 years ago and the children's health insurance program less than the last 15 years. we have the opportunity to listen to people who come up to us on the street or who send us an e-mail or send us a letter. it just so happens that one of my constituents in pennsylvania just sent us a note the other day, just literally two days ago, november 28, and i won't give away her identity, but i'll

give you a general sense of what her challenge s she wrote us to talking about her two children who are covered by the children's health insurance program in pennsylvania. by the way, pa pennsylvania is e of the stirs states to -- is one of the first states to put in place this program. but she wrote and said she was concerned that the house in their bill had made some changes that would adversely impact her situation. she said, and i am a quoting from part of her letter, "we qualify for free children's health insurance program chip benefits in pennsylvania but my husband's income is greater than the 150% of the federal poverty level, which means our children won't qualify for the coverage under the house's proposed plan." then she says, "this has terrified us." unquote. she goes on to talk about her own -- she and her husband, what they're frying to do to make ends meet. she says "our water bill will

increase and we're nervously awaiting the annual increase in heating." suffice to say, we have a program in place right now, the children's health insurance program chip, that works for families right now and now we're engaged in a great debate on health care on the floor of the united states senate and we deal with programs like the children's health insurance program. what we have to make sure is we do nothing in this process to injure or harm or set limits on what we can do with a program that we know works. this is a program which is good for a child to make sure he or she reaches the full potential of that light inside them. this is good for his or her family. just imagine the peace of mind that a mother, a father has in the course of a day, whether they're going after work or whether they're home, to know that they are child has health care. yet we have, some families, some

parents, terrified, even with the coverage that thervetion worried that that coverage -- even with the coverage that they have, worried that that coverage won't remain with them. so we have to make shiewrks as the chart on my left says, that that rule is followed -- no child worse off in america. we want to fix what works and build upon -- fix what's broken on the one hand build oandbuild. we need to make sure what the difference is between these benefits and what could happen down the road. one of the things that will have an adverse impact on our health care system generally but in particular on a program like children's health insurance program will be the skyrocketing costs of coverage. scare of household income spent on premiums is climbing. the new america foundation reports that in 2008, household income spent -- and on the side here, percent of median household income spent on health

care -- 26%. that's pretty -- that's far too high right now. as of 2008. with no action -- if we just stay where we are, go down the same road that we've been going on, status quo, don't change anything, let's start over and keep scratching our head about this, here's what's going to happen by 2016: seven years away, that median household income dedicated to health care will skyrocket to 45% nationally. unfortunately, in pennsylvania it goes up over 51%. instead of 45%. so that's the "do nothing" path. do nothing and we can guarantee that those cost costs going to p going up and up and up. go to the next chart. i said before the children's health insurance program works. by the way, when that bill passed and when it's been reauthorized, we've had help from both sides of the aisle. sometimes not enough help.

but we've had help supporting that -- supporting that program. we know that this program works. because we can see from the results achieved by our children because of this program. but let's just -- let's just compare this to some other challenges in our system right now. in our economy right now. the national poverty rate, 2007, a little more than 37 million americans in poverty. 12.5% of the population. 2008, it's up to 13%. so poverty rate going up. -- going up from 2007 to 2008. child poverty rate going from 18% to 19%. almost a million more kids in one year falling into poverty because of the changes in our economy. people without health insurance, 2007 v. 2008, that's gone up. it may only be 15.3 to 15.4, but

look at the overall number, from 45.7 to 46.3. so everything's going up. right? we'd expect that as -- as tragic as that is, we expect that when times are bad. national poverty rate up. child poverty rate up. and the uninsured rate is up. what's not gone up between 2007 and 2008 are -- are children's health insurance numbers. 8.1 million kids in 2007 covered. and 7.3 million kids covered in -- in 2008. so that's good news. -- that's good news that the number of uninsured children is actually going down from eight -- from roughly eight down to seven. that's good news. now, why is that happening? it's not magic. if we didn't have a children's health insurance program, that number would go up like poverty,

child poverty and the uninsured number. why is the uninsured number for children going down? one basic reason -- you could point to a few others. one fundamental reason. we have a program that is called the children's health insurance program which works. and fortunately we reauthorized just a couple of months ago. thank goodness we did that or more and more children would fall into poverty. now, we are on a path now to go from -- to go from 7 -- i'm sorry, to go from the number of children who are insured to get that number, it's now in the double-figure millions, to get that to 14 million children. so have that -- have that uninsured number keep going down and cover more and more children. in a couple of years we'll have the opportunity to say that in america we have 14 million kids covered. so what we have to do is make sure that with a successful program that works for the child, that works for their

family, and works for our society, because guess what? what we're going to have a better economy because of the children's health insurance program. you invest in a child early, they get health care, they learn better. when they learn better, they're going to do better in school and get a better job and have a higher skill level. this whole debate about children's health insurance, is not just a nice thing to do. it's how we compete around the world in a tough economy. it's how we build a skilled workforce in a tough economy. it's how we build strong families. so this isn't just some nice program. this has real results for our economy, for gross national product growth, for economic growth, for a skilled workforce. fill in the blank. you could add 10 themes to that in terms of the impact of this legislation. but we have to be careful. in the midst of this health care reform debate, we have to make sure that we don't do what some have urged, which is to take the children's health insurance

program, this program that we know works in -- and drop that into the health insurance exchange that will be created as a result of this bill. the exchange is a good idea to cover a lot of people. this happens to be a bad idea when it comes to merging or putting the children's health insurance program in there. it needs to remain a stand alone program. one of the reasons why we can say we're at that point where it is a stand alone program still is because during the debate in the finance committee, senator rockefeller, senator jay rockefeller of west virginia, ensured that we kept the children's health insurance program out of the exchange and that the program would continue to 2019. unfortunately the house doesn't have the same provisions and we want to make sure that we do that by the end of the debate here. so i filed an amendment today to make sure that children are protected by health care reform. so that we can truly say that no

child is worse off as a result of our health care reform bill. in a nutshell this amendment will strengthen and safeguard insurance for children rap championship from 2019 and beyond with whatever changes the future of health care reform brings. i will have a couple of highlights. i know i'm over my time. it continues funding through 2019. it ensures that children have access to the essential care they need. it streamlines and simplifies enrollment. the amendment also provides financial incentives for states to increase enrollment much the eligible, but uninsured children and calls for a study of children under the children's health insurance program compared to coverage of children under the so-called insurance exchange. so there are just some highlights of my amendment we'll be talking more about it. but i want to conclude with this thought. and i know that -- that senator baucus was on the floor a moment

ago, the chairman of our finance committee who has worked very hard on this -- this bill -- this program, i should say, children's health insurance, and on the health care reform bill overall to protect our kids. but i returned to this letter i just got two days ago from a mother saying to us, in essence, commending the benefits of this program. this program gives her peace of mind. but what we have to do is make sure that we keep the children's health insurance program intact and, if anything, strengthen over time so that this mother doesn't have to worry again. she doesn't have to be, to use her words, to be terrified, of changes that will adversely impact her two children. especially in the midst of a bad economy, but even if it weren't. so, madam president, i will yield the floor and thank you for this time. a senator: madam president? the presiding officer: the

senator from wyoming. mr. enzi: madam president, i thank the senator from pennsylvania for his comments. i certainly hope that no one who's listening thinks that anybody wants to make any child worse off. i think that's a basic premise, and i appreciate him pointing out how the house potentially makes some children worse off. i really want to constrain my comments to the medicare amendment. because i think that's one of the key parts of this whole bill. i would -- i would comment that -- that senator -- the senator from pennsylvania mentioned that there wasn't a -- a republican bill. actually there are four republican bills and there's one bipartisan bill that meets all of the goals that the president put out. when we were going through the "help" committee process, we put one of those out and it was voted down with one vote. and we said, that didn't work very well. there are a lot of good ideas in there. they ought to have to consider every one of those. we have been putting our ideas

out wawnt a time so -- one at a time so hopefully something would be gleaned out of there to be part of the bill. all of the bills couldn't be on one side of the aisle. now, we began the day with a kind of a stunt which, of course, was to have the leader propose a unanimous consent. and he proposed that the social security money ought to stay with social security. i don't think there's any problem with that. but then he proposed that the class act money ought to stay with the class act. well, that's a -- that's not actuarially sound. it's just a piece of the bill. it isn't in existence around here. and he left out what he really should have put into that unanimous consent. he should have said, medicare money should be reserved for medicare. that would have relaxed a lot of seniors around this country. of course it would have been untrue and impossible to pass this bill if that were the u.c.

because medicare money is going to expansion of new programs outside of medicare. that's what's upsetting seniors. and it ought to. medicare, as everybody has said, is going broke. see, that's a government option. never mind. but medicare is going broke. we all agree on that. so why would we tak take $464 billion out of medicare to use on other programs? and then recognize that medicare is going broke and throw in a special commission that will come to us once a year and suggest cuts to medicare? well, that's not a bad idea. but some side deals have been made in this whole thing that keeps that from being a very realistic option either because the hospitals can't be cut anymore. the doctors, well, we're going to have to fix that, and that's where some of the phony

accounting comes in on this. the pharmaceuticals, the deal made for the doughnut hole, yes, that will provide extra help to seniors through the doughnut hole, but it has to be on brand name products. we know that generics are a lot less expensive and a lot of seniors switched to generics when they hit the doughnut hole and have to switch and want to save a few dollars. that isn't going to be a possibility. the deal made with the pharmaceuticals, they -- they're going to pay their percentage on brand name products only. why would they do that? if they can get you to use brand name products through the doughnut hole, when the government pays again, you'll still use the brand name. one of the ideas of health care is to get a little skin in the game for everybody. so they're making good choices on health care. how much of a good choice are you going to make if you don't have to make a choice and you keep on doing what you've been doing whether it's the best choice for you or not. whether it's even what the

doctor agrees with. and even if it's a whole lot more expensive for the government to keep medicare going. so i have to rise to support senator mccain's motion to recommit this bill and eliminate its medicare cuts. senator reid's bill cut cuts $476 million. it will eliminate cuts for medicare patients. it will make it harder for them to see doctors and other health care providers. it will threaten nursing homes and home health agencies. don't take my word for it. the administration's own chief actuary reviewed the house bill with the medicare payment cuts and reached the same conclusion i just said. richard foster, the chief actuary at the centers for medicare and medicaid services, c.m.s., wrote if these cuts take affect, many providers could find it difficult to remain profitable and might end their

participation in the program. he also noted this could jeopardize medicare beneficiaries access to care. i've heard similar messages from doctors, home health aides and nursing practitioners back in wyoming. they're concerned about the half a million dollars in medicare cuts and their ability to treat medicare patients. i've heard from folks from the star valley senior citizens, the southwest sub lett county -- sub let county pioneers, and from many other wyoming nursing homes about how the $15 billion in medicare cuts to nursing home patients will devastate their ability to provide care for seniors in wyoming. many of these nursing homes are small businesses. they struggle to make payroll every month and deal with an ever increasing burden of government regulations. yeah, we've never cut those back. they tell me how the medicare payment rates have already been reteased and how the additional cuts in the bill could force

them to close their doors. connie jenkins, the executive director of the star valley senior center, wrote about the important role that nursing homes play in rural towns in wyoming. she noted that -- quote -- "in a rural state such as ours closure of nursing homes would mean families traveling further to visit their loved ones. and in some case loss of access all together." in the rural states and we're about as rural you can get. we have the least population in the nation and we have a lot of land mass, there's a lot of distance between towns. and if the nursing home in your town closes down, it's a long way to the next nursing home. the reid bill would also cu cut $135 billion in medicare payments to hospitals in a state -- in a state like wyoming with an older population, 30% to 50% of the hospital's revenue comes from medicare. medicare already pays a fraction of what private insurers pay and the cuts in this bill will

undermine the hospital's ability to continue to operate. i've heard from several wyoming hospital executives that because of the payment cuts in this bill, they're going to need to ask their people to work fewer hours and take pay cuts. they also say they may need to lay some folks off. and to find ways to scale back the services they offer to their patients. they don't want to compromise the care they provide, but the payment cuts in this bill will not leave them a choice. now, the reid bill also cuts nearly $8 billion in payments to hospice care. hospice care helps to relieve the suffering of people who are dying from diseases like cancer. these are terminal patients. terminal patients that aren't going to be cured but the hospice is intended to help manage the pain and other symptoms of the patients with the terminal illness and working with the families. much on a volunteer basis. now, according to the national hospice and palliative care

organization, the cuts in the reid bill combined with prior regulatory cuts would reduce medicare payments to hospice providers by 14.3% through 2019. according to a june, 2008, report from the medicare payment advisory commission, hospitals already operate with narrow profit margins that average just 3.4%. smaller nonprofits and hospices in rural areas like wyoming already operate with negative profit margins. many depend on charitable fundraising to keep their doors open and to enable them to keep treating patients. the reid bill will further cut their medicare payments by $8 billion. this will force many hospices to close which will threaten dying seniors access to that type of care. the reid bill also cuts more than $40 billion in medicare payments to home health agencies. according to the analysis done by one industry association, this level of cuts could put nearly 70% of all home health

agencies at risk of having to close their doors. i want to say that again. the $40 billion in medicare cuts to home health agencies, according to an analysis done by one industry association, could put nearly 70% of all home health agencies at risk of having to close their doors. there are a lot of people that are out of nursing homes because they're getting home health. if we eliminate the home health, we drive up the cost of care. if the senate passes this bill, it will mean the medicare patients may not be able to get the skilled nursing care, the physical and speech therapy, and the assistance that home health aides provide with many daily activities like dressing, bathing, helping patients live more fully with a disability. the medicare cuts in the reid bill are not limited to slashing payments to hospitals and other providers. the bill also cuts $120 billion from the 11 million seniors on medicare advantage. these cuts make a mockery out of

president obama's promise that if you like what you have, you can keep it. as a result of these cuts, millions of medicare beneficiaries will lose the benefits currently provided by medicare advantage plans. supporters of senator reid's bill have tried to gloss over the impact these medicare advantage cuts will make, arguing that they will only result in a loss of extra benefits. for the seniors who come to rely on medicare advantage plans to provide thingsprotectionsastrhia benefits, but items and services they depend on. we all agree that medicare needs to be strengthened and reformed. its finance something unsustainable. the hospital insurance trust fund which pays for hospital services will be insolvent in 2017. the physician payment formula which calls for medicare payments to doctors to be cut by more than 40% over the next ten years is fundamentally broken, and we know that, and we even had a vote on that in this

chamber. we said they had to be paid for. let's see. $464 billion coming out of medicare. medicare is what's being affected by the doctors' payments. why wouldn't we use some of that? but it's a lot of money. it's a lot of money. but it's not as much money as we're taking out of medicare. unfortunately, the reid bill does nothing to fix these problems. instead, it cuts half a trillion dollars from medicare to create a brand-new entitlement program for the insured. this program -- for the uninsured. this program fails to address the real problems facing medicare. that's the physician formula. instead, it uses the same gimmick that congress has repeatedly used to fix this problem. it provides a temporary fix in 2010 which will actually lead to steeper cuts in subsequent years. physicians have grown increasingly frustrated by congress' repeated failures to replace the current payment formula. we kind of like to keep them hanging on a year at a time, i think. it's a little bit of a hostage situation, but that's the way that washington works it. it shouldn't be that way.

we should we do the formula. now, if we don't address this problem soon, many more physicians are going to decide that it's just not worth it to continue to treat medicare patients. the congressional budget office has estimated that truly fixing the physician payment formula could cost upwards of of $250 billion. yet, the reid bill doesn't address this problem. spiraling costs associated with medical liability lawsuits directly increase medicare costs. these costs are calculated directly into payment formulas for providers like physicians. in addition, physicians and hospitals ordered billions of dollars in extra tests and procedures to protect themselves from the threat of potential lawsuits. we know that enacting commonsense medical liability reforms directly reduces the liability insurance premiums doctors pay. we've seen the results in states like texas where physicians' liability insurance premiums have decreased every year since

the state enacted reforms. with average liability rates dropping a total of 27%. now, the reid bill does nothing to address the problems with medical liability. instead of including reforms that would help reduce medicare costs and extend the solvency of the program, the only thing of the reid bill is include a meaningless sense of the senate resolution on liability reform. that won't pay the bills. we owe it to the 43 million people who depend on medicare to reject the arbitrary cuts in the reid bill. we need to come up with better solutions that will not endanger their ability to see a doctor or to get care at a hospital or a nursing home. yeah, if we don't pay the doctors, the doctors won't take them, because medicaid, they already won't take 40% of the patients. in medicare, it's 20% already and a lot of people are being asked when they call the doctor if they are a medicare patient. it's my contention that if you can't see a doctor, you don't have any kind of insurance at all, and we don't take care of

that problem. so we do need to come up with a better solution that will not endanger the ability to see a doctor or to get care at a hospital or a nursing home or to have home health care. i believe we can do better. if the senate passes this motion to recommit, we can develop bipartisan reforms that will eliminate the unsustainable payment cuts and address the underlying problems facing the medicare program. i yield the floor. the presiding officer: the senator from iowa. mr. grassley: i'm not in favor of doing nothing. the previous democratic speaker, senator casey, said if we do nothing, costs will go up. i think that the fact is that if you look at c.b.o.'s analysis that says costs will go up even more, if this bill, this

2,054-page bill passes. so i want to spend some time because there has been some obfuscation on what this congressional budget office letter to senator bayh really means. this morning, the nonpartisan congressional budget office sent a letter to senator bayh providing a very detailed analysis of what health insurance premiums will look like as a result of this 2,054-page bill, and i have the letter from the congressional budget office right here if anybody wants to read it in detail. like many of us, senator bayh wants to know if the reid bill is addressing our constituents' number one priority -- costs. and i think if you were to have

a saturday morning coffee club meeting in almost any of the small towns of america, and they were discussing health care reform -- and emphasis upon the word reform -- and i walked into that meeting and if i told them under this 2,054-page reid bill that costs were not going to be brought under control, taxes were going up, premiums were going up and we were taking taking $400 billion out of medicare to set up a new health care program, they would probably unanimously respond, well, that doesn't sound like health care reform to me. well, a lot of senators are concerned about costs because that's what we're hearing from the grassroots of america. everyone from the dean of harvard's medical school to even

"the new york times" has said this bill does not sufficiently address the rising costs of health care. but before today, we were still all anxiously waiting to hear what the congressional budget office has now said about that issue of rising costs. well, today c.b.o. has spoken loud and clear. the reid bill not only fails to bring down costs, it will actually raise costs for millions of americans. i think that bears repeating. the reid bill will make health insurance more expensive. families will end up paying 10% to 13% more as a result of this

2,054-page bill. now, some proponents of this bill are trying to spin this very -- what they consider unfortunate news and tell the american people that taxpayer-funded subsidies will actually offset these cost increases. in fact, tonight some members have already been saying that this c.b.o. analysis shows costs will come down, but i want to make it very clear c.b.o. says that that's not the case. well, this may be true if you take $500 billion of taxpayers' hard-earned money and give it out in subsidies directly to insurance companies. sure. some people may end up paying less for health insurance, but this argument fails to recognize two big underlying problems.

first, most americans will not qualify for any subsidies. they'll just end up paying higher premiums. in fact, 160 million americans that stay in employer-based plans won't see any help. in fact, despite all the rhetoric about how employers can't afford the status quo, c.b.o. says this bill does little, if anything, to lower costs for employers. maybe that's why the national federation of independent businesses, the u.s. chamber of commerce, and a host of other business groups oppose this 2,054-page bill. the nonpartisan congressional budget office goes on to say that 14 million people who can't get coverage through an employer

won't get any help either, but they will see a 10% to 13% increase in premiums. and, of course, an intrusive new insurance mandate will be enforced by the i.r.s. if you don't do what has never been done in a 225-year history of north america. never has the federal government said any american had to buy anything. now you have to buy insurance. if you don't buy it, pay the i.r.s. more money. now, some people are going to say well, you've got to buy car insurance, but under the tenth amendment, the federal government -- or the state governments have any powers that aren't prohibited by the federal constitution to them. so families that would have paid

paid $1,100 under-- $13,100 under current law will actually pay $15,000 as a direct result of this 2,054-page bill. and people in employer-based coverage will be paying more than $20,000 a year for health insurance in 2016. now, the second big problem is this -- health insurance premiums are still more expensive in the reid bill than they would be under current law. the government is just cutting medicare and raising taxes to offset the increases. so instead of addressing the underlying issue of costs like was promised, this bill enacts policies that drive up costs by close to 30% and then hands over close to $500 billion in hard-earned taxpayer dollars directly to health insurance

companies to offset the increases. well, you may not believe the spin. in fact, you better not believe the spin because the nonpartisan congressional budget office has confirmed it. this bill fails to drive down costs of health insurance premiums. it simply drives up prices with a bunch of arbitrary regulatory reforms, very acutely shifting the costs on to the american people in the form of higher taxes and massive medicare cuts. so once again, don't take my word for it. read what the nonpartisan congressional budget office says. they have confirmed what we have been hearing for months -- the democratic leadership bill means higher costs for millions of

americans. i yield the floor. a. a senator:: i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: quorum call:

bs jrks quorum call:

quorum call:

according to madam president? the presiding officer: the sphror illinois. mr. dorgan: i ask that the quorum call being suspended. the presiding officer: without objection. mr. dorgan: i ask that the senate freed period of morning business with senators permitted to speak up to 10 minutes each. the presiding officer: without objection. mr. dorgan: i ask that two fellows in the office of senator pryor be granted floor privileges during the consideration of h.r. 3590. the presiding officer: without objection. mr. dorgan: i ask unanimous consent that the senate proceed to the immediate consideration of senate resolution 364, submitted earlier today. the presiding officer: the clerk will report. the clerk: s. res. 364, supporting the observance of senate diabetes month. the presiding officer: without objection, the senate proceeds

to the measure. mr. dorgan: i ask that my name be added as a cosponsor. the presiding officer: without objection. mr. dorgan: i ask unanimous consent that the resolution be agreed to, the preamble be agreed to, the motions to reconsider be laid on the table, with no intervening action or debate, and any statements related to the resolution be placed in the record at the appropriate place as if read. the presiding officer: without objection. mr. dorgan: madam president, i ask unanimous consent that when the senate completes its business tatted it adjourn until 10:00 a.m. tomorrow, tuesday, december 1. following the prayer and pledge, the journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders object reserved for their use later in the day, and the senate resume consideration of h.r. 3590, the health care reform legislation. for debate only until 11:30 a.m. with the republicans controlling the first 30 minutes, the majority controlling the next 30 minutes, with the remaining time equally divided and controlled between the two leaders or their designees, and with senators permitted to speak therein for up to 10 minutes each. further that at 11:30 a.m., the senate proceed to executive session to consider the nomination of calendar number

487, jacqueline nguyen, as provided for under the previous order, and finally, i ask that the senate recess from 12:30 until 2:45 allow for the weekly caucus loons. the presiding officer: without objection. mr. dorgan: at 12:00 noon, the senate will proceed to vote on conversation of the nguyen nomination. value that willing the first vote of the day. following the caucus luncheons, the senate will continue debate on the health care legislation. if ness no further debate to come before the senate, i ask that it adjourn under the previous order. the presiding officer: the

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challenge the strengths. deadline is january 20. winning entries will be shown on c-span. currently cambra and get started. >> at an international congress last week a team of scientists represented pining for the health impact from the reduction of greenhouse gas emissions. here's the opening session that feature comments by u.s. and world leaders including the world health organization and humans are cat thing sibelius. it is hosted by the national institute of environmental health sciences. >> it's an important day. we've had a very good morning session and were of course talking about the public health impact of climate change mitigation. and i'm very much looking forward to this session. so we're delighted to be able to link to you in washington and

this is the opportunity to announce the findings of this key series of studies which have been funded from both sides of the atlantic and of course as everyone will remember al gore described climate change as an inconvenient truth. but the study findings today are actually a more convenient truth because they've got the opportunity to improve public health while at the same time mitigating the worst effects of climate change. and i think the other nice thing about having the meeting in this way is that it shows we can have international events without a huge carbon footprint. and so we haven't put too much money into the airline business to have this meeting. so welcome to you all. chris, are you there? >> yes, we are here. welcome to you. we are sorry we missed your earlier discussion, but we in the morning with a bit early even for me.

we've had a low carbon breakfast, hopefully. and got a nearby low-carb entrance port or the metro. with that, i think i will just turn it over to you. i've made opening comments here and i will let you get us started. thank you very much. >> okay, thank you very much. thank you very much indeed. and i'm going to start by introducing three messages that have been recorded for us. first, we're going to hear from becky moon, united nations secretary-general. and then straight after that we're going to hear from the honorable thing sibelius was the secretary of the u.s. department of health and human services. and then we are going to hear from margaret chan, the director general of the world health organization. and then after that it will be my pleasure to introduce to you andy bergmann dissenters of state for health. over to the videos.

>> secretary of state for health and he bore none, honorable of health and human services kathleen sibelius. medical professionals, ladies and gentlemen, it is a pleasure to join all those who have gathered in london and washington d.c. for this event. i congratulate the researchers who have walked with each other and with the world health organization to produce this important study on the links between climate change and mitigation and global public health. in just two weeks, people from around the world will meet in copenhagen to forge a response to one of the most fundamental challenges of our time. copenhagen can and must be a turning point in the war's efforts to reduce emissions and

protect people and the planet. we need an agreement in copenhagen that traps the past to healthier, cleaner, more prosperous future for all. climate change affects every aspect of our lives. it could pose on one of the centuries greatest risks to health. rising temperatures mean more mosquitoes are increasing the spread of diseases like malaria. changing weather patterns will affect food production and water supplies. the results could be more nutrition in the poorest of countries. the good news is that solutions to climate change are also good for our health. in developing countries, cleaner households can reduce respiratory infection and avoid millions of premature death.

greater use of transportation and bicycles means cleaner air and fewer respiratory problems. it also means that people will be more fit. and it's important to say that eating less meat will also minimize our impact on the environment and help reduce greenhouse gas emissions. the message is clear. climate change is about our health and the health of our planet. we are all in this together. i call on every citizen and every government to make copenhagen a success. i urge everyone to add his or her voice to the voice being heard around the world calling for climate action and for a safer, healthier future for us all. thank you.

>> good morning. i wish i could be with you today, but i'm home in kansas city visiting my family. to everyone else will be enjoying stuffing and mashed potatoes tomorrow, i want to issue a happy thanksgiving. i also want to acknowledge our other speakers this morning. secretary-general moon, who you just heard from, secretary of state for health and director general chan. the more we learn about the common thread the more we understand that this is a problem that no country or organization can solve on its own. it doesn't matter who puts the greenhouse gases into the sky, we all face the consequences. so this is one problem on which we have no choice but to work together. that's why gatherings like this one and the copenhagen meeting a few weeks from now are so important. if we are going to build a clean

energy future that benefits all the people in the world, we need to share what we've learned, listen to each other's good ideas, and work together. that's our only chance to meet this challenge. am i me be clear. this isn't just about danger for our planet. filling the sky with carbon dioxide has national security consequences. it has economic consequences and as we continue to learn, it has health consequences, too. relying on fossil fuels leads to unhealthy lifestyles, increases our chances of getting sick and in some cases takes years off our lives. that's the message the lansing study we are talking about today. and i want to thank the international research team that conducted the study and all the funders including the national institute of environmental health sciences because you called attention to the connection that we sometimes been too slow to see.

we know that depending on coal power plants that spew greenhouse gases is bad for our planet. but it's also bad for our health. since it increases the prevalence of diseases like asthma and cancer. we know that the growing share of meat in our diet is bad for our planet, but it also can be bad for our health if we don't eat balanced meals. we know that depending on gas guzzling cars for transportation is bad for our planet, but it's also bad for our health, since it can lead to get less exercise and increase our risk for cardiovascular disease. we're seeing more and more studies that show the connections. the same results are showing up in countries around the world. when greenhouse gas emissions go down, so dudas from respiratory and cardiovascular diseases. this is not a small effect. a recent study by our national economy of sciences found that here in the united states burning fossil fuels leads to

almost $120 billion in health costs a year. most of those costs are premature deaths. and we know that the cost in human lives can be even higher in countries with emerging economies that have fewer resources to improve air quality. for all of these reasons, president obama and i understand that we cannot wait any longer to act. president obama has made it clear that he's committed to passing comprehensive energy and climate legislation that will create millions of new jobs and to secure clean energy sources that are made in america and work for america. but in the meantime, we're looking for ways that we can start reducing the threat right now. as friday, i saw some of you at a white house stakeholder briefing i hosted with lisa jackson, the administrator of our environmental action agency. at that briefing, we talked about many of the steps my department is taking in this area from funding research on

the health cost of greenhouse gas emissions to investing in communities, to help them respond to climate related disease, to slashing greenhouse gas emissions in our own buildings. this is not an afterthought for my department. this is a key part of our broader public health strategy. more and more, we understand that health is not something that happens just in doctors offices. whether you're healthy or not depends on what to eat and drink, what you breathe, how you get around, and where you this. a world that's eating up and powered by paul fired plants that fill the sky with harmful greenhouse gas is going to have fewer healthy people that a world that runs on clean, renewable energy. that's why even if our planet was not in jeopardy, even if energy independence was not crucial to our national security, and even if clean energy was not a huge economic opportunity, reducing greenhouse gas emissions would still be an

urgent priority for us. it's a key to building healthier country and a healthier world. and we know that kinds of changes we need to make won't be easy. there are entrenched agencies that profit from the status quo and we have a lot to learn about the best ways to reduce the harmful effects, especially when it comes to health. but we can't afford to delay action. this is not a distant abstract problem. this is the jobs of tomorrow and to the health of our children today. we need to get to work. thank you. >> greetings from the world of organization in geneva. the effects of climate change are already being felt. evidence of the harm to human health continues.

climate change will aggravate help problems that are already huge. a largely concentrated in the developing world and difficult to combat. no one can delve this anymore. already, nearly 1 billion people live on the margins of survival. it does not take much to push them over the brink. foreign security, scarcity, storms, floods, drought, population displacement, and polluted air. all of these events have a well-documented impact on health. sadly, policymakers have been slow to realize that the real bottom line of climate change is threat to human health. although the situation is improving, i have personally attended high-level conference

on climate change warehouse was treated as a peripheral issue. this must change. health concerns need to be at the center of the debate. the impact on human health is the most significant measure of the harm done by climate change. this reality should add to the urgency of negotiations taking place next month in copenhagen. policies for mitigating the impacts of climate change must align with policies for protecting public health. the study is being launched today take this argument a step further and the news is good. as the studies show, strategies from climate change can actually be beneficial for health. if they are wisely chosen. in my view, what makes these

studies so important is their contribution as new evidence and arguments that can guide the assessment of alternative strategies for mitigation. motivate wise choices and bring value and added benefits. these studies make a strong case, a strong case for linking the climate and health agendas. in many cases, a wise choice of mitigation strategies brings substantial benefits. good choices help address some of the biggest and fastest-growing global health challenges like acute respiratory infections, cardiovascular diseases, obesity, cancer, and diabetes. moreover, the health benefits are immediate and local, making them attractive for politicians and the public alike.

the recommendations coming out of the studies are extremely reasonable and make good sense. they bring clarity to issues, often with confusion and disagreement, especially when questions of cost and responsibilities entered the debate. by selecting mitigation measures that bring benefits for health, policy makers sees an important social opportunity and ensure a broader return on their investments. i congratulate the authors of these studies, the institutions and agencies who supported them and the lancet for its online publication of the findings. it is my sincere wish that the arguments that are in the studies will shape the discussion during the copenhagen conference. your efforts today are giving

this work a most appropriate, high-level profile. thank you. [applause] >> well, those were three splendid presentations. and it's now my enormous pleasure and play but to introduce live and in person andy barda with the secretary of state for health and has had a very thing which career in politics. so you actually know all of the issues about government crosscourt nation and all of the issues from different departmental prospectives around climate change. and i think we are delighted you've agreed to address us on the situation. so, andy. >> thank you very much mark for that kind introduction and it's great for me to be here with colleagues in london and also our friends in washington.

while any health minister has to deal with the daily press of health policy there is no more important than meeting the attempt to share on this one. though i want to thank everybody here in london and in washington for giving their time to be here today. i'd also like to thank all of the organizations on both sides of the atlantic that has made it possible. i want to start by endorsing the words of secretary sibelius, margaret chan, and ban ki-moon. this is a crunch year for climate change. when the world comes together in copenhagen in just a couple of weeks time, it will be essential that we strike a deal that is equal to the challenge we face in which the speakers before me have outlined. climate change poses a huge threat to global prosperity,

security, and development. but to many people, it can seem abstract without nonurgent event. it's when we think of the impact on people's health, the terrible cost of inaction it becomes clear. this human cost of climate change has had relatively little attention in the international debate, so we are shining a light on it today. and i too congratulate the landsat on this timely report. temperature changes of just a few degrees can have huge consequences for health. the 2003 he waved in britain led to over 2000 excess deaths and yet average temperatures that gear which is 2 degrees higher than normal. although we can't in attribute individual event to climate change we can expect that extreme weather like we are seeing in cumbria at the moment to increase at the moment. in fact, the uk climate

projections suggest that if temperatures increase by 2 degrees the wettest day of autumn could see about 25% more rainfall in my home region, the northwest. and if temperatures increase by 4 degrees we can see around 35% more. the health implications of routes and heat waves are clear. and indeed are being felt now. i know that he went into some detail this morning. and as often as the case it is those least responsible for causing the problem who are likely to suffer first and suffer most. the average somali is about 100 times more likely to die as a result of climate change than the average american despite admitting roughly 16,000 times less carbon. in kenya, colleagues and the ministry of health have told us that malaria is moving up land. the diseases being found in areas that were previously too

cold for mosquitoes to breed and less. the diseases could spread in new and unpredictable ways. and in haiti poverty climate change and environmental degradation have come together with terrible consequences, almost 90% of children are chronically infected with intersessional parasites from the dirty water that they have no choice but to drink. now as you all know and i'm sure this is true in the u.s., too. politicians are fond of quoting statistics. i sometimes trip up the tongue without giving enough back to their meeting. what if nothing else, i would ask any fellow health minister around the world to bring the following statistics that i'm about to quote to the attention of their president or prime minister in advance of copenhagen. and they are these: by 2080, climate change could mean an extra 600 million people worldwide are affected by malnutrition. an extra 400 million people could be exposed to malaria and

an extra 1 billion people would be living without enough water. this could be the human face of climate change if we fail to act, suffering human suffering on an unimaginable scale. but we will act as prime minister gordon brown has made clear and that is why the united kingdom is pushing so hard for an ambitious global deal at copenhagen, a deal that works not just for us but were also the world's poorest people. to gather health ministers and professionals across the globe must work to highlight the clear and present danger the global warming poses to our communities. we must work to design effective climate change policies that bring real benefits for health. indeed, many of the steps we need to take to tackle climate change will help us lead longer and healthier lives as the secretary sibelius said. low carbon transport could reduce air pollution and reduce

physical activity. a big increase and buckling and cycling would reduce pollution and improve health. in our change for life campaign is making a big difference for giving people more active. more than 370,000 families have artie found that. better housing insulation could keep people cool in summer. and import countries, cleaner energy could reduce the need of solid fuel indoors with a potentially significant impact to people's health. in the uk, the climate change act means that everyone has a role to play, cutting carbon emissions under our carbon. just like every other sector. we all need to be part of the solution and today i want to call in the health community here to set an example and be advocates for change to demand action we need to prevent climate change from endangering people's health and well-being around the world. so this week, i've written to my

health administers and 60 countries around the world to tell them about this research. i want to encourage them to work with me through the world health organization, the eu, and bilaterally to ensure that help is at the heart of our fight against climate change. the chance to reduce the spread of infectious diseases on a safeguard supplies of food and clean water and create a healthier environment is the price of a global deal. and it's a price that we have to win. the future of global health depends on it. thanks very much for listening this afternoon and let's all go out and play our part in making it have been. [applause] >> okay, thank you very much indeed secretary of state. i think the messages we are hearing today are absolutely crucial and of course what we've now got to do is act on them. and i think you've agreed to

answer a couple of questions from the audience. so, let's start with andy haines who is the senior author of some of the work we have done. andy? [laughter] >> well, thank you very much. i want to ask you building on your how can we can bring up joint thinking on this issue. we heard from the secretary of state there are a number of issues that will be resistant to the number of policies we are opposing to be introduced. how do you think we can overcome some of that resistance? >> okay, well it's a very important question. and i think we've gone some way to achieving what you want, but have we gone far enough like snow, i'm sure there's much more we can do. and part of it is not having government pulling in different directions.

it's about identifying the things we can do, where we achieve a range of object does. change for life is and is daycare where it is a campaign that the department of health has launched two attacks obesity and people to lead healthier lifestyles. clearly it has huge environmental benefits, too. and the potential to help people reduce their carbon footprints. if we make a real appreciable impact on physical activity for instance, then we can as a country, make a major step towards delivering our commitments. britain is somewhere in the relegation places of the world league table of physical activity. for me there's no reason for that and it actually doesn't cost any public money to lift britain from its current place closer to the levels of activity in netherlands, germany, and scandinavia. in my department, the interest

in my department will absolutely be foursquare with interest a rat department. there is no differentiation here. there is no conflict team and it's really starting to align government and really using all of its way around those same object is where they could make the transfer system flow more quickly. we can get people healthier and then we can encourage people to reduce their carbon. government has got to get a bit better at that, a bit more focused on how it is doing. we just bought a cycle to work scheme. we all came together and when the combined power of government departments get together you can begin to make significant change and leave some behavior change. that it does make that kind of conservative action taken on both in the past we have not enough. clearly the change needs to happen now. >> a lot of hands went up. >> thank you very much. it's clear from everything we've

heard that we need to put climate change and sorry health right at the center of the climate change negotiations. looking at the european union position paper from copenhagen which is a 13 page document, health appears only once in a single word on page six. i wonder if you could comment on this and i wonder if you could also tell us what's in your view would happen if there is no international agreement at copenhagen? >> thank you very much. i'll begin by saying there's no important meeting this year. before actually said it i hesitated. i thought, do i really mean that. i thought all the other meetings all the heaven and the next couple of days. but in fact, i do. and i think that is part of the problem here perhaps help politics and ministers around the world are very absurd on their own domestic problems, but we don't lift our heads enough to look at the bigger picture, the big challenge that is coming and the devastating effects for

public health around the world if we don't. and i think inevitably that has manifested into health ministers aren't making their self a priority then it doesn't reflect in the documents that's come out of government and out of multilateral organizations. and i think this is an area where you can begin to connect climate change with the very real concerns of the public. we've had i think we've done fantastic work in this country and raising awareness of poverty in africa. but actually, these are the same issues. these are also going to be deepened and intensified if we don't take action on climate change. perhaps it is about refreshing our message, making it more impactful when we speak to the public. and i think it does remove when you talk about the examples that

i did when we talk about how they can make a very human face of this suffering in a very of real time. i think it begins to remove it from the abstract and into the direct on the human. and that's what we need to do more. but more. but acknowledging that as health minister's visit to be on our agenda more often than it is. i've many bilateral meetings with ministers around hand on heart. should it be? of course it should. >> have you got time for one more question? question in the back. can you say who you are please? >> i'm an individual concerned about health and climate change. i was just wondering whether you're going to copenhagen as early today we had it would be good of health ministers attended or if he weren't, what you're planning to do in order to rally? i know you said you wrote letters, but what was in the letters? should they do something prior

to the event and what could they do more than just suggest to the president that helps an important issue? >> well, i'm not planning to go at the moment. those daily troubles of the nhs are probably keeping me from making the trip. but that should not in any way diminish what i can do in advance of the summit i have written. i fully appreciate that writing a letter is not enough. you know, perhaps i can get on the phone to people. i know kathleen sibelius. i know the health ministers around the world. i think it is important to start to get that voice up in this debate. and i think that's what is so important about today. if we can get that voice up in the debates around this world, i think you can start to make people listen. perhaps people who were not listening before. and i certainly resolved to play my part in doing that. so i would always be open to suggestions on how you think i could do more.

i think what i can also do is make the nhs an example in this regard. is it doing enough to promote physical activity for its staff for the most sustainable lifestyles and then making a connection with health? i'm not sure it is actually. i think we can do more. i think a better look in my own backyard. but at the same time, take those examples and speak with confidence on the world stage. ..

so we wish you well and all of your tasks and thank you very much, indeed, for comment. [applause] >> secretary of state hillary clinton and other members of the obama administration are at a white house forum to discuss efforts to combat hiv and aids. this event comes on the eve of tomorrow's world aids day. it is 30 minutes.

>> good afternoon. members of the president's cabinet, members of congress, members of the diplomatic corps, ladies and gentlemen, welcome to the white house. and good afternoon. we are here today and on the eve of world aids day 2009 to commemorate this important day of remembrance and recommitment. we have come a long way in responding to the hiv pandemic but we have a much important work left to do. out like to acknowledge some of the key leaders whom we have with us today. first a champion among all congressman barbara ley, where are you? please thank you. [applause]

>> congressman lee is chairman of the black caucus and she taught me that she flew back from much warmer climates to be with us here today. of she had long been a champion and for people living hiv/aids. we also like to welcome mayor, mr. mayor, please thank you. [applause] the mayor, of course, of our home town and the district of columbia. joining us is also gail smith, special assistant to the president and senior director for development and democracy who is responsible for global health policy of the national security secretary, gail, where are you? i know i cited. [applause] the president's commitment to hiv/aids is demonstrated by the strong leadership of the team he has assembled within his administration and we are so fortunate today to be joined by some of the administration's top leaders of this area.

anna hiv/aids and so first we're going to hear from secretary clinton then we will hear from secretary kathleen sibelius, she will be followed by the ambassador at large of the global aids coordinator, and i'm also pleased to welcome a special guest here who will be speaking after the doctor, who is the president-elect of the international aids society and finally you'll hear from geoffrey crowley, of course, the director of the white house office of national aids policy and senior adviser on disability policy and he will give the closing remarks today. we have a major accomplishments to celebrate. major accomplishments but we also know that there is much work to be done. the president's commitment to fighting hiv/aids as personal and during the course of his career he has traveled around the country and in touch by so many people across the country who are fighting with hiv/aids right now. he has said the that we are

always, not always very good at talking about hiv and we have to do a better job of talking about it's in our places of worship, throughout our communities, organizations, our schools and, of course, our workplace. my commitment to fighting hiv/aids is also their personal. you may have noticed as arrived in the white house that we have panels commemorating a aids memorial quilt and all around the white house and we also have a large red ribbon displayed at the front of our white house. i cannot see this without thinking about the people in my own life who have lost their lives as a result of aids. i wash my sister-in-law got a tragic death, i saw members of her family and her five year-old daughter as we all struggle with her death. i've also had close friends who have either passed away as a result of aids among living with aids right now so it's a very deep and personal commitment from a. we have members of the white house staff who have hiv and has a black woman i also have to say

that it's heartbreaking to see how many black women are affected by it hiv and aids. black women haven't 15 times greater chance of being infected than white women, within the african-american community that accounts for 13 percent of the population in the u.s., almost half of the incidences', 46 percent of the new infections are within the african-american community. the news about hiv, however is not all grim. in addition to launching the global health initiative, the president has made a commitment to developing a new national hiv as a strategy. this won't make every problem go away but it does create a real opportunity to make further strides in our government's efforts to combat hiv/aids. one thing we know about president obama is that he makes his decisions grounded, in fact,. one of the tracks about hiv is it's always been a disease disproportionately impacts underserved and disadvantaged

communities. on in our country this includes communities of color, gay, bisexual men, people dealing with addiction and people who are homeless. and in recognition of it world aids day let's recommit ourselves to increasing awareness about how to prevent the spread of hiv and ensure access for all people living with the disease. with the sound like to introduce you to secretary clinton. thank you. [applause] >> as a salaried leaves i want to thank her for her leadership on this and some issues here at the white house and the administration and, for her personal testimony as to the importance of this issue for her, for president obama, from all of us. we are gathered on the eve of it

world aids day to renew and recommence ourselves. it is obvious to those sitting in this audience as i looked out at you and see people who have been involved in the struggle for a long time, that you know and that we have made progress but we face an un ending in pandemic. one that spares no one, that unfortunately disproportionately affects most of all honorable, and which is the defining health challenge of our times. we have to address its through a series of labrada and crosscutting global partnerships and a whole of government approach to. and that is exactly what we are attempting to do. we know the ravages and complexities of an hiv/aids here at our own country and we know many of us what it looks like

around the world. on but we can take some heart in the progress that has been made over the last two decades. access to antiretroviral chairman and low and middle income countries has risen tenfold in the last five years. new hiv infections have fallen by 17 percent over the last eight years and much of that progress has been due to the concerted efforts of the united states government and our partners. i want to applaud president bush for making a serious commitment to american leadership in combating hiv/aids. his administration and spearheaded the creation of pepfar, the president's emergency plan for aids relief, and by supporting its implementation and activities to the united states has made the largest ever in history by any nation to combat a single disease. i remember well serving as a

senator from new york how there was bipartisan support on behalf of this initiative and an extraordinary commitment of dollars and technical assistance that backed it up. pepfar has provided life-saving antiretroviral treatment to over 2 million men, women and children worldwide. other partnerships with other government and ngos we have supported care for more than 10 million people including 4 million orphans and vulnerable children. and pepfar efforts to prevent mother to draw the transmission have helped nearly 240,000 hiv-positive mothers give birth to children who are hiv free. so it is clear that our nation's investments are having an impact and president obama is dedicated to enhancing american leadership in the fight against global aids with pepfar serving as the cornerstone again -- of our

global health initiative to combat a better and more sustainable health outcomes. later this week ambassador tuesday will present the five-year strategy for the future of pepfar. out on in the import a role that pepfar will play in transitioning from emergency response to sustainable health systems. that help meet the broad at medical needs of people with hiv and the communities in which they live. in its next phase of pepfar programs will support a comprehensive whole of government approach in many countries to increase awareness, reduce stigma and get services to people at earlier stages. obviously our efforts are hampered in. whenever discrimination or more rationalization of certain populations results in less effective at region treatment. so we will work not only to ensure access for all who need it also to combat discrimination more broadly.

we have to stand against any efforts to marginalize and criminalize and penalize members of the algae pt community worldwide. it is an unacceptable step backwards. [applause] on behalf of human rights but it is all so a step that undermines the attractiveness of average to fight the disease worldwide. we will also redouble our efforts to address the needs of women and girls who are disproportionately affected by hiv/aids in many parts of the world. promoting the health of women strengthening families and communities and has a positive spillover effect in areas like poverty reduction and education. since we know the most effective health programs are integrated with functioning local and national governments will work

with partner governments to assess capacity, identify gaps, and make customized plans to meet each country's needs. that means treating more programs like the ones that ambassador -- ambassador goosby and i visited in africa over the summer in the in andover example our pepfar partnership brummer supports the country's hiv national city did plan to strengthen that the healthcare infrastructure their. we visited a clinic in south africa which we co-sponsored with the south african government and heard from patients who not only received care but also supports as they face the stigma associated with hiv/aids. our investments in pepfar, the global one and overall global health have a positive difference and will continue our support, but we have to do more. we have to make sure that our programs foster conditions that improve people's lives and in turn and promote stability, prosperity and security. in this time of very tight

budgets and our own government and our own people suffering from unemployment, from other kinds of cutbacks in services, we have to do more even here at home. we have seen some of the results of that the cutbacks that are happening at the state and local level. so while we're talking about our commitment to internationally let's not forget our fellow citizens who are suffering right now. and then we also have to make the case to our fellow citizens that our investment in dealing with the pandemic worldwide is in america's interest. so we are committed to doing so. president obama is implementing the repeal of the hiv entry ban on longstanding policy that prevented people living with hiv/aids from entering our country. the repeal will take effect early in the new.

we will be vigorously enforcing it. today i am pleased to announce that with a repeal of the ban, the international aids society will hold the 2012 international aids conference in washington dc. [applause] this conference will draw together an estimated 30,000 researchers, scientists, policy makers, health care providers, activists and others from around the world. so as we look to 2012 we have to continue to seek a global solution to this global problem and world aids day and let us renew our commitment to ensuring that those infected and unaffected by hiv, the women on chairman who is supporting her family, the child who dropped at a school to care for sick

parents, the doctors and nurses without adequate resources, that all those who have joined together to fight this pandemic will someday live in a world where hiv/aids can be prevented it and treated as a disease of the past. i thank you all very much. [applause] >> well, it's my great pleasure to have an opportunity to join in secretary clinton not only on the stage today but more of the ridley to work on this important issue nationally and internationally, i think the collaboration and cooperation between the department of state and the department of health and human services has never been stronger. and ambassador goosby, thank you for your great work and it's

great to have the international ambassador here at the white house. this is an example of the kind of collaborative efforts that is under way to combat the spread of a aids into deal with the pandemic worldwide. we are pleased to join secretary clinton and welcoming back the international aids conference to the united states and i want to also like knowledge that valerie has already talked about congresswoman lee, but without her tireless efforts of this would not be announced today. i reminded her of that during my early confirmation visits the first thing she asked me was when is that ban going to be lifted it. [laughter] i reminded you're that i was not yet the secretary but i would be happy if confirmed to take it on. the aids and ghariban, the hiv

entry ban was a policy that tore apart families, kept people from getting tested, forced others to hide their hiv status, and wargo life-saving medications. and most of all it didn't reflect america's leadership infighting the disease around the world. so it was fulfilling to sign the papers, to get rid of it the entry ban earlier this year. that really delivers on a commitment made by president obama during his campaign and for the presidency when he made the case that this man had to go. so we celebrate on the eve of bonnet world aids day, this step forward. but we have to read knowledge as we make the step forward is that we have a long way to go. you heard from secretary clinton about the great success pepfar has had, but we also know there are way too many places were too

many people are acquiring hiv and dying to young from this disease. so in the pepfar next phase our challenge will be to build on the successful interagency model we've created under the leadership of secretary clinton ended ambassador goosby. and that means working with partner governments to create the kind of local health of the structure that we can sustain for how the improvements we're aiming for. and as of the head of the department that has over a thousand employees and more than 30 countries, working to implement pepfar, i can tell you hhs is very excited to take this next tap. and i wanted knowledge the fact that we have many department leaders with us today, the head of our health resources services administration, leadership from the national the sothos of health, from a the secretary's office and my assistant secretary, there are just representative of the team at

hhs eager to work collaborative lee on this challenge. in as big as our challenges and opportunities are around the world, we can't forget that there is a lot more work to be done here at home. according to our latest data, more than 56,000 americans are newly elected with hiv each year. and what's more disturbing is this number isn't going down. in our results are changing, that our actions have to change. and that's why this summer the president obama launched an ambitious campaign to develop a national hiv/aids strategy. that will reduce the spread of hiv a come increase access to care, and improve health outcomes for people living in the country with hiv. hopefully eliminating hiv related health disparities right here at the united states. as part of that campaign, the director of our office of

national aids policy, jeff crowley, and my department have spent the last few months posting community meetings around the country to hear from state and local leaders and americans living with hiv/aids about what the components of the new domestic strategy should be. what we know is we need to do a lot better job of reaching the groups that have the hardest hit by hiv/aids. in washington d.c. mr. mayer i am sure you are aware that one in 16 african american men are hiv-positive. and if you look at just the gay men in the community, the numbers are even more staggering. in 2005 at the centers for disease control found that in five major cities almost half of all african-american gay men are hiv-positive. that's why we recently launched a $45 million hiv education campaign, it's our first federal hiv education campaign in over

20 years and it's specifically targeted to underserved communities including racial minorities, women, gay and bisexual men. we're also taking steps to make sure that americans get the care they need. earlier this year we reauthorize the ryan white hiv/aids program. which provides lifesaving care to the more than half a million americans and we will continue to work with congress to pass health insurance reform that will prevent americans from being denied coverage because of their hiv status and because they have a cap on their out-of-pocket expenses. this world a day, we remember those whom we have lost, we look back on the lives to have been saved, and we rededicate ourselves to reaching all those affected. by hiv/aids. not just around the globe, but in our home communities and in

communities across the country. and to talk more about the announcement we are making today, i'd like to introduce a man who's been working to help people with aids for as long as we've had a name for the disease, ambassador goosby. ambassador. [applause] >> well, thank you, thank you. it is really an honor to speak to you today, secretary clinton, jeff crowley, valerie, thank you secretary for the introduction. i like to offer special greetings to the member of the diplomatic corps from pepfar partner countries to join us today. we are greatly appreciative of their presence and revalue their partnership with us as we look for to moving ahead together. i see really more people than i can count in the audience who are old friends that we have worked with our many years going

through much of the epidemic, indeed, a last time we had an international aids meeting in the united states was in san francisco. it was 1989 so it has been a longtime. world aids day it evokes memories for many of you as a surly does for me and urgency around providing preventive care and treatment services as fuelled by the memories of those we have lost. some elias unrealized and potentials on matt. in my first month in this attention i've seen the dedication of those who made pepfar a reality run the world. as those of us who spent time in africa before and after pepfar no, it's human impact has been truly profound and continues to reverberate. it's important to acknowledge the work of president george bush as secretary clinton did in a bipartisan congress in

creating and continuing to support pepfar. the american people can truly be proud of the work that is taking place and of the dedicated people were doing this work. [applause] yet it is equally true -- it is equally true that to the global aids emergency is far from over. the country still struggle with a vast unmet needs, there are massed unmet needs in our own country. we need to work harder and smarter than ever before laying the foundation that countries can build on for the long term. later this debate as secretary clinton mentioned, we will release a new pepfar five-year strategy that reflects what we have learned from the program's first five years. it will be followed by the release of annexes providing additional information in more detail on the evidence based prevention it coming integration of programs, increase capacity building efforts among other topics. pepfar five-year strategy will

focus on sustainability. and response -- sustainable responses. programs that our country on a country driven, programs that address hiv/aids in the context of a broader health needs by people by -- programs that build on our successes and corporate efficiencies, programs that work with governments to support policy change to address discrimination, including as the secretary noted earlier the situation in uganda. it will not be an easy task to transition our emergency response especially as we maintain high quality of services but the move toward it sustainability is an essential one. as we expand our hiv prevention care and treatment efforts we need to engage with cavallo international and bilateral partners to create a shared vision of a global response to this global responsibility. i want to offer my thanks to secretary sibelius' for hhs support role as she mentioned in implementing it pepfar over a

thousand hhs employees dedicated to the implementation and evaluation and improvement of the programs. and for its action to end the entry ban for people living with hiv, a major step. the removal of the entry ban moves us closer to reduce the stigma and discrimination associated with the disease worldwide. it is a shining example of their wrath. the stigma and discrimination against both people living with hiv and most at risk population hinder our ability to provide an effective prevention, care and treatment services. this important support delivery but also the policies needed to remove barriers to equality and accessible care. as secretary clinton also noted the removal of the entry ban that pays a the way for the u.s. to post the international aids conference in 2012 for the first time since the end of the 1980's. all of us are engaged in this work domestically or

internationally, we rely on new data to deepen our understanding of the signs around this hiv, the international aids conferences, important for generating and that disseminating the science and the program implementers look forward to it deepening our partnership with international aid society. i thank you very much for this opportunity, i want to introduce my friend and colleague president-elect of the national aids society. [applause] >> i am honored to join secretary clinton and sibelius, ambassador goosby, valerie jarrett, and jeffrey today. i'm delighted to be here for the announcement that washington d.c. will be the site for the 19th international aids conference in 2012.

the international aids society is the world's leading independent association for hiv professionals with 14,000 members from the 190 countries. if -- we want to convene a the biannual conference international conference. the conference pays a vital role in bringing together scientists, community activists and leaders from all over the world to evaluate the recent developments , to force the debate and dialogue, and to move forward to find the end of the aids pandemic. as of 2012 will bring together more than 25,000 people from up to 200 countries in washington d.c.. a city that is itself deeply impacted by the aids epidemic.

as a the president elect of the international aids society, i will be very proud to serve as international co-chair of the aids 2012 along side my colleague dr. down hatfield will be the u.s. co-chair. the doctor is here with other members of the national aids council including our current president, dr. montana.ç i ask -- we decided to hold the aids 2012 and washington d.c. following president obama announcement that the united states will end the restrictions on people living with hiv. this change is a significant victory for public health and human rights. it calls on all countries that